Journal of Veterinary Internal Medicine最新文献

Background: Erythropoietic effects of molidustat, a hypoxia-inducible factor-prolyl hydroxylase inhibitor, occur in anemic cats with chronic kidney disease (CKD).

Hypothesis/objectives: To evaluate the effectiveness and safety of molidustat in managing anemia in cats with CKD.

Animals: Seventy-five client-owned anemic cats with CKD in the effectiveness and safety phase and 64 in the safety continuation phase.

Methods: Multicenter, randomized, double-masked, placebo-controlled field study. Cats in the 28-day effectiveness and safety phase received 5 mg/kg of molidustat (n = 40) or a control product (CP; n = 35), once daily for 28 days. During the 20-week safety continuation phase, all cats received 5 mg/kg molidustat in 28-day treatment cycles once PCV declined to < 28%. Individual cat treatment success, defined as a ≥ 4% point increase in hematocrit (HCT) compared to baseline, was evaluated on day 28. Safety was assessed throughout both phases.

Results: Proportion of molidustat-treated cats with treatment success on day 28 (68% ± 7.4%; 95% CI, 51.45-80.28) was significantly higher compared to CP cats (17% ± 6.4%; 95% CI, 7.80-33.59; P < .001). During the safety continuation phase, median treatment cycle duration was 28 days with treatment intermission medians ranging from 11 to 18 days. There was no evidence of adverse effects attributed to molidustat when administered alone or in combination with other medications.

Conclusions and clinical importance: Molidustat significantly increased HCT values in treated cats compared to CP cats. Repeated 28-day treatment cycles were well-tolerated. Molidustat is an effective and safe treatment for long-term management of anemia in cats with CKD.

Background: Cross-sectional imaging, with particular regard to computed tomography (CT) and magnetic resonance imaging (MRI), has been shown to be accurate in the diagnosis of intervertebral disc extrusion (IVDE) in dogs, with MRI having higher diagnostic accuracy. However, the cost-effectiveness of veterinary diagnostic imaging has not been investigated.

Hypothesis/objectives: Comparative evaluation of the cost-effectiveness of 5 cross-sectional imaging strategies in the diagnosis of thoracolumbar IVDE.

Animals: No live animals were used.

Methods: A probabilistic decision-analytical model was developed based on a hypothetical cohort of dogs suspected to have thoracolumbar IVDE. Five imaging strategies based on a combination of noncontrast CT, CT-myelography (CTM), and MRI were tested (CT-only, noncontrast CT only; conditional-CTM, noncontrast CT followed by CT-myelography if nondiagnostic; unconditional-CTM, noncontrast CT followed by CT-myelography; conditional-MRI, noncontrast CT followed by MRI if nondiagnostic; MRI-only, MRI only). Effectiveness was defined as the probability of a correct diagnosis.

Results: Across probabilistic simulations, CT-only and unconditional-CTM were consistently less effective and more costly than other options and therefore were never preferred (strictly dominated). Magnetic resonance imaging-only was less cost-effective than strategies based on noncontrast CT (extendedly dominated). Conditional-CTM and conditional-MRI provided the best balance of diagnostic accuracy and cost (the non-dominated efficient set of strategies).

Conclusions and clinical importance: Conditional imaging strategies beginning with noncontrast CT and escalating only if nondiagnostic were the most cost-effective strategies in diagnosing thoracolumbar IVDE in dogs. An MRI-only strategy was rarely cost-effective despite similar diagnostic sensitivity. From this decision-analytic modeling study, strategic use of cross-sectional imaging in the diagnosis of thoracolumbar IVDE has the potential to optimize the use of finite resources.

Background: Detecting bacteremia in calves is essential to identify those calves with systemic infections that could benefit from antimicrobial therapy.

Hypothesis/objectives: To determine the prevalence of bacteremia in neonatal calves with diarrhea in a commercial setting and investigate the association between clinical and blood variables with bacteremia.

Animals: One hundred neonatal calves with diarrhea.

Methods: Case-control study. Clinical and laboratory variables were analyzed using exact conditional logistic regression and classification analysis and regression tree (CART) to evaluate their association with bacteremia, which was determined by blood culture.

Results: The prevalence of bacteremia was 37% (37/100). The most frequently identified bacteria were Streptococcus ruminantium and Escherichia coli. In the multivariable model including all the clinical and laboratory variables, HCO3- (for each 1 mmol/L increase odd ratio [OR]: 0.78; 95% CI, 0.60-0.95 mmol/L) and albumin concentration (for each 1 g/dL increase OR: 0.67; 0.43-0.93 g/dL) were associated with lower odds of bacteremia on the first day it was detected, whereas the presence of scleral injection was associated with increased odds of bacteremia (OR: 10.75; 95% CI, 11.11-inf.). The CART indicated that low heart rate (< 98 beats per minute), enophthalmos (> 2.5 mm), lower monocyte count (< 0.63 x 109/L) and red cell distribution width (< 23%) were important predictors of bacteremia in diarrheic neonatal calves.

Conclusions and clinical importance: Scleral injection, greater rectal temperature, enophthalmos, electrolyte derangement, and lower RDW and albumin concentration could be used to identify bacteremia in diarrheic neonatal calves.

Background: Transfusions in camelid species are performed without evidence-based guidelines. Safe and recommended practices for administering blood products with maximal efficacy and minimal risk of reactions are needed.

Hypothesis/objectives: To describe the indications for, methods of, and outcomes associated with transfusions in camelids and to identify risk factors for transfusion reactions (TRs) and death.

Animals: Two hundred four transfusions performed in 169 camelids at 2 referral hospitals.

Methods: A dual-center retrospective review of medical records from 2010 to 2024. Signalment, indication for transfusion, transfusion history, administration of premedication, presence of TRs, and survival to discharge were reviewed. Dose and rate of product administration were calculated. Data were described and analyzed with a generalized linear model.

Results: In less than 1-month-old crias, the most common indication for plasma transfusion was management of failure of transfer of passive immunity. The overall TR rate was 12%, and presence of TRs resulted in a lower probability of survival to discharge (54.6%; 95%CI, 34.0%-73.6% vs 76.5%; 95%CI, 69.5%-82.3%, respectively; P = .033). There was no difference in probability of a TR with respect to administration of premedication, rate of transfusion administration, or previous transfusions (P ≥ .06). Changes to vital signs were the most common findings suggesting a TR.

Conclusions and clinical importance: Blood products can fulfill many therapeutic needs in the treatment of camelid species with a reasonable expectation of safety. A history of prior transfusions does not appear to significantly affect the future risk of a TR.

Background: Frunevetmab is a felinized anti-nerve growth factor monoclonal antibody that alleviates osteoarthritis (OA) pain in cats by blocking nerve growth factor (NGF) signaling. While its efficacy is established, comprehensive real-world safety profiles remain limited.

Hypothesis/objectives: To analyze frunevetmab-associated adverse events (AEs) using real-world data from the United States Food and Drug Administration (FDA) Animal Drug Adverse Events (ADAE) database.

Animals: Adverse event reports submitted for cats receiving frunevetmab, extracted from the FDA ADAE database (January 2022 - December 2024).

Methods: Disproportionality in frunevetmab-associated AEs was assessed by calculating the reporting odds ratio, the proportional reporting ratio, the Bayesian confidence-propagation neural network, and the multi-item gamma Poisson shrinker.

Results: From 33,378 feline AE reports, 5,248 frunevetmab-specific reports were analyzed. Frunevetmab-induced AEs spanned 24 system organ categories. Among the 19 significant preferred terms (PTs) identified, the most frequently reported AEs included pruritus, unspecified skin disorders, alopecia, dermatitis and eczema, and unspecified skin lesions. Notably, the AEs with the highest signal strength were skin ulceration, unspecified skin disorders, unspecified skin lesions, injection site pain, and dermatitis and eczema. In addition, unexpected significant AEs (e.g., abnormal cytology, arthritis, paresis) were detected, all of which were absent from the package insert.

Conclusions and clinical importance: We identified new potential AE signals for frunevetmab, emphasizing the need for robust clinical monitoring. Although these hypothesis-generating findings from disproportionality analysis require validation, they offer immediate, valuable guidance for veterinarians to optimize the safe use of this treatment in cats with OA.

Background: Chat Generative Pre-trained Transformer's (ChatGPT) ability to generate client educational materials for use in practice is unknown.

Hypothesis/objectives: To assess the educational quality of ChatGPT-generated client handouts for common internal medicine diseases. We hypothesized that ChatGPT can be used to efficiently generate easy-to-understand, accurate handouts for client education.

Animals: Small Animal Internal Medicine (SAIM) diplomates and pet owners were administered 2 separate electronic surveys.

Methods: Client handouts on diabetes mellitus (DM) and immune-mediated hemolytic anemia (IMHA) in dogs and inflammatory bowel disease (IBD) in cats were generated by using a standardized prompt in ChatGPT-3.5. Electronic surveys were distributed to both pet owners and American College of Veterinary Internal Medicine (ACVIM)-SAIM diplomates.

Results: Pet owners (n = 50) reported a greater understanding of each disease process after reading the handouts for DM (Z = 5.865, P < .001), IMHA (Z = 5.953, P < .001), and IBD (Z = 5.508, P < .001). Median pet owner satisfaction scores (reported on a scale of 0 to 5, with 0 indicating poor satisfaction and 5 indicating maximal satisfaction) were 4 for DM, 4 for IMHA, and 5 for IBD. Many diplomates reported that they would use the handout on DM (n = 48/67; 71%), IBD (n = 47/62; 76%), and IMHA (n = 32/64; 50%) with either "minor" or "minimal to no" revisions.

Conclusions and clinical importance: Although some refinement is warranted, ChatGPT-3.5 was able to successfully generate client educational handouts for common internal medicine diseases.

Diabetes mellitus (DM) in cats is commonly managed with insulin injections and glycemic control is assessed with glucose monitoring systems. Automated insulin delivery (AID) systems, which integrate a continuous glucose monitoring system with an insulin pump controlled by a set algorithm, are successful in managing type 1 DM in humans but have not been reported in cats until now. Here, the use of an AID system is described in an 11-year-old cat with DM. After an initial 6 days of treatment with twice daily administration of protamine zinc insulin and insulin glargine, the AID was applied and managed by the cat owner. The system rapidly improved glycemic control and remission of DM was achieved. Throughout the application period, the AID system was well tolerated by the cat. This case suggests that AID systems can be used in diabetic cats and that they might improve glycemic control.

Background: Dysglycemia is common in critically ill neonatal foals. Continuous glucose monitoring systems (CGMS) are potentially useful in these cases, but factors such as poor peripheral perfusion could interfere with results.

Hypothesis/objectives: Evaluate the correlation, agreement, and accuracy of CGMS compared to point-of-care glucometry (POCG) and laboratory analysis (LAB) in critically ill neonatal foals and assess the impact of hypotension on CGMS measurements.

Animals: Fifteen critically ill, client-owned neonatal foals.

Methods: In a prospective method comparison study utilizing clinical cases, glucose concentration was measured serially using CGMS and POCG (every 6 h), and LAB (every 24 h) for pairwise comparison. Blood pressure was measured every 12 h.

Results: Average bias (95% limits of agreement) between CGMS and LAB, POCG and LAB, and CGMS and POCG were 48 mg/dL (-27 to 111), 10 mg/dL (-23 to 45), and 38 mg/dL (-21 to 98), respectively. Spearman's correlation was significant between CGMS and LAB (r = 0.65), POCG and LAB (r = 0.77), and CGMS and POCG (r = 0.75). The CGMS accuracy was low with only 15.5% of CGMS concentrations within 15% of LAB concentrations, compared with 88.3% for POCG. Hypotension did not affect CGMS measurements.

Conclusions and clinical importance: The CGMS provided glucose measurements above both LAB and POCG concentrations. Given its low correlation and accuracy, CGMS cannot replace LAB or POCG as the sole glucose measurement method in critically ill foals. However, it is a useful adjunct for tracking trends and providing alerts.

Background: Biomarkers to identify dogs at risk of developing seizures after surgical attenuation of congenital portosystemic shunts (CPS) have not been defined.

Hypothesis/objectives: To prospectively characterize perioperative electroencephalographic findings in dogs with CPS undergoing shunt attenuation, and to evaluate their association with outcomes after attenuation.

Animals: Twenty-eight client-owned dogs with CPS enrolled prospectively.

Methods: A prospective cohort of dogs presenting with no overt signs of encephalopathy underwent ambulatory electroencephalography (EEG) before and after CPS attenuation. Electroencephalography background activity and presence of epileptiform or encephalopathic features were assessed qualitatively. Quantitative analysis evaluated the mean dominant frequency and relative power of EEG frequency bands.

Results: Dogs with a normal pre-attenuation EEG (n = 24) did not develop early-onset (<7 days) PAS; however, 8% (2/24) experienced late-onset seizures (>30 days post-attenuation). Four dogs had abnormal pre-attenuation EEG. Two of these dogs developed early-onset seizures and 3 dogs (75%) died before discharge due to worsening neurological signs (n = 2) or immediate postoperative complication (n = 1). Pre-attenuation covert encephalopathy defined by EEG showed a combination of epileptiform features (4/4), abnormal background rhythm (3/4), and a lack of graphoelements of sleep (2/4). Median ammonia concentration (range) was 102.5 μg/dL (34-401) in non-encephalopathic dogs and 145.5 μg/dL (56-275) in dogs with covert encephalopathy.

Conclusions and clinical importance: Electroencephalography could provide useful diagnostic biomarkers to identify dogs at high risk of developing neurological complications after attenuation of CPS. In this cohort, dogs with no abnormalities detected on preoperative EEG had favorable outcomes during their hospitalization.

Background: The consensus recommendation is to medically dissolve suspected struvite uroliths in dogs. However, more data is needed on outcomes for protocols using therapeutic multipurpose urinary foods formulated for both struvite urolith dissolution and calcium oxalate urolith prevention.

Hypothesis/objectives: To describe outcomes for medical dissolution of suspected struvite uroliths in dogs using a therapeutic multipurpose urinary food and concurrent or recent antimicrobial therapy.

Animals: Thirteen client-owned dogs with suspected struvite uroliths.

Methods: Single-institution, retrospective case series (observational) of dogs fed a therapeutic multipurpose urinary food for dissolution of suspected struvite uroliths. Dogs had to be treated with antimicrobials concurrently or have an absence of bacteriuria on urine microbial culture after recently completed antimicrobial therapy. Follow-up abdominal imaging was required. Patient and urolith characteristics, dissolution outcomes, and complications were summarized.

Results: Complete urolith dissolution occurred in 9 (8 with cystoliths and 1 with nephroliths) of 13 dogs included in the study. Mean time until documentation of complete dissolution was 71 ± 52 days. Eight of the dogs with complete dissolution had bacteriuria less than 60 days prior to urolith diagnosis. Mean duration of antimicrobial therapy for dogs with successful dissolution was 66 ± 49 days. All dogs without complete dissolution had uroliths with non-struvite shells (composed of 80%-100% calcium). No dog developed a urethral obstruction during the dissolution trial.

Conclusions and clinical importance: Struvite uroliths can be effectively dissolved in dogs with a therapeutic multipurpose urinary food and antimicrobial therapy. A non-struvite urolith layer is a common cause of unsuccessful dissolution.